BACKGROUND AND OBJECTIVE: Photodynamic therapy (PDT) with topical δ-aminolevulinic acid (ALA) of non-melanoma skin cancers is often associated with treatment-limiting pain. A previous study on basal cell carcinomas (BCCs) at Roswell Park Cancer Institute evaluated a two-step irradiance scheme as a means of minimizing pain, preserving outcomes, and limiting treatment time. We used an initial low irradiance until 90% of the protoporphyrin IX was photobleached, followed by a high irradiance interval until the prescribed fluence was delivered. Success of this pilot investigation motivated integration of the protocol into routine practice. Here, we present a retrospective review of recent clinical experience in a broad patient population. STUDY DESIGN/ MATERIALS AND METHODS: This was a retrospective review of an existing dermatology database. Fourteen caucasion patients-nine men and five women, ages 18-80, with a total of 51 superficial and 73 nodular BCCs, and three Bowen's disease lesions-were included. ALA was applied to each lesion for approximately 4 hours. Lesions received an initial irradiance of 30-50 mW/cm(2) for 20 J/cm(2) , followed by 150 mW/cm(2) for a total fluence of 200-300 J/cm(2) . Pain was assessed using a visual analog scale (VAS). Clinical outcome was determined at 6-12 months. RESULTS: Median VAS scores were 1.0 for both irradiances. Five of 127 lesions required pain control with 1% xylocaine. Pain was strongly influenced by lesion location but not by lesion type, number, or size. Complete responses were achieved in 84.1% of BCCs, which compares favorably with reported results for single ALA-PDT treatments. Two of three Bowen's disease lesions showed a complete response. Complete responses for nodular BCCs were 37%, which are also within the range of reported outcomes. CONCLUSIONS: A two-step irradiance protocol in ALA-PDT effectively minimizes pain, maintains excellent clinical outcomes in superficial lesions, and adds minimal treatment time.
BACKGROUND AND OBJECTIVE: Photodynamic therapy (PDT) with topical δ-aminolevulinic acid (ALA) of non-melanoma skin cancers is often associated with treatment-limiting pain. A previous study on basal cell carcinomas (BCCs) at Roswell Park Cancer Institute evaluated a two-step irradiance scheme as a means of minimizing pain, preserving outcomes, and limiting treatment time. We used an initial low irradiance until 90% of the protoporphyrin IX was photobleached, followed by a high irradiance interval until the prescribed fluence was delivered. Success of this pilot investigation motivated integration of the protocol into routine practice. Here, we present a retrospective review of recent clinical experience in a broad patient population. STUDY DESIGN/ MATERIALS AND METHODS: This was a retrospective review of an existing dermatology database. Fourteen caucasion patients-nine men and five women, ages 18-80, with a total of 51 superficial and 73 nodular BCCs, and three Bowen's disease lesions-were included. ALA was applied to each lesion for approximately 4 hours. Lesions received an initial irradiance of 30-50 mW/cm(2) for 20 J/cm(2) , followed by 150 mW/cm(2) for a total fluence of 200-300 J/cm(2) . Pain was assessed using a visual analog scale (VAS). Clinical outcome was determined at 6-12 months. RESULTS: Median VAS scores were 1.0 for both irradiances. Five of 127 lesions required pain control with 1% xylocaine. Pain was strongly influenced by lesion location but not by lesion type, number, or size. Complete responses were achieved in 84.1% of BCCs, which compares favorably with reported results for single ALA-PDT treatments. Two of three Bowen's disease lesions showed a complete response. Complete responses for nodular BCCs were 37%, which are also within the range of reported outcomes. CONCLUSIONS: A two-step irradiance protocol in ALA-PDT effectively minimizes pain, maintains excellent clinical outcomes in superficial lesions, and adds minimal treatment time.
Authors: T Dirschka; P Radny; R Dominicus; H Mensing; H Brüning; L Jenne; L Karl; M Sebastian; C Oster-Schmidt; W Klövekorn; U Reinhold; M Tanner; D Gröne; M Deichmann; M Simon; F Hübinger; G Hofbauer; G Krähn-Senftleben; F Borrosch; K Reich; C Berking; P Wolf; P Lehmann; M Moers-Carpi; H Hönigsmann; K Wernicke-Panten; C Helwig; M Foguet; B Schmitz; H Lübbert; R-M Szeimies Journal: Br J Dermatol Date: 2011-12-21 Impact factor: 9.302
Authors: B W Henderson; T M Busch; L A Vaughan; N P Frawley; D Babich; T A Sosa; J D Zollo; A S Dee; M T Cooper; D A Bellnier; W R Greco; A R Oseroff Journal: Cancer Res Date: 2000-02-01 Impact factor: 12.701
Authors: M B Ericson; C Sandberg; B Stenquist; F Gudmundson; M Karlsson; A-M Ros; A Rosén; O Larkö; A-M Wennberg; I Rosdahl Journal: Br J Dermatol Date: 2004-12 Impact factor: 9.302
Authors: Nathalie C Zeitouni; Ulas Sunar; Daniel J Rohrbach; Anne D Paquette; David A Bellnier; Yi Shi; Gregory Wilding; Thomas H Foster; Barbara W Henderson Journal: Dermatol Surg Date: 2014-12 Impact factor: 3.398
Authors: Ana Luiza Ribeiro de Souza; Ethan LaRochelle; Kayla Marra; Jason Gunn; Scott C Davis; Kimberley S Samkoe; M Shane Chapman; Edward V Maytin; Tayyaba Hasan; Brian W Pogue Journal: Photodiagnosis Photodyn Ther Date: 2017-10-14 Impact factor: 3.631
Authors: Madeeha Shams; Barbara Owczarczak; Patricia Manderscheid-Kern; David A Bellnier; Sandra O Gollnick Journal: Cancer Immunol Immunother Date: 2014-11-11 Impact factor: 6.968